Technical Pitfalls and Proposed Modifications of Instructions for Use for Endovascular Aortic Aneurysm Repair Using the Gore Excluder Conformable Device in Angulated and Short Landing Zones

Authors

Andrea Vacirca
Titia A L Sulzer
Thomas Mesnard
Aidin Baghbani-Oskouei
Laura Ocasio
Thanila A Macedo
Hence J M Verhagen
Robert Rhee
Gustavo S Oderich

Publication Date

12-1-2023

Journal

Journal of Vascular Surgery: Cases, Innovations and Techniques

Abstract

We describe a case of an abdominal aortic aneurysm (AAA) and angulated proximal neck treated with a Gore Excluder conformable endoprosthesis and show relevant technical pitfalls in the deployment of the graft main body. An 82-year-old man presented with a 71-mm asymptomatic AAA with an angulated infrarenal proximal neck (75°) and was referred to our unit. The patient was treated with a 26-mm Gore Excluder conformable device, which was deployed slightly above the renal arteries after precatheterization of the lowest renal artery. The graft was then repositioned with support of the introducer sheath and a stiff guide wire. The proximal sealing zone was ballooned before the endograft delivery system was retrieved to avoid distal migration. Technical success was achieved. The patient was discharged with no complications. No type Ia endoleak was present on the 6-month computed tomography scan. Endovascular treatment of an AAA with a severe angulated proximal neck can be effective with a conformable stent graft if technical measures are used during deployment of the main body to optimize the seal.

Keywords

Abdominal aortic aneurysm, Angulated proximal neck, Endovascular aortic repair